Heavy workers compensation and auto exposure, both of which are governed by state schedules rather than your commercial contracts. In California that plays out against a specific set of rules rather than a general one.
Claims for California providers are adjudicated by Noridian Healthcare Solutions (JE), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
At a glance
Coding driver
Timed treatment codes, where unit calculation is systematic rather than occasional — an error repeats on every visit.
Medicare contractor
Noridian Healthcare Solutions (JE)
Medicaid program
Medi-Cal
Auto injuries
Tort state — health plan sequencing applies
What changes in California
Medicaid in California runs as Medi-Cal and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.
California prohibits fee splitting generally while authorising percentage-based billing arrangements subject to conditions. Our own pricing in California is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.
Where physical therapy claims fail
- Unit counts that do not match documented treatment time
- Visit caps reached without notice
- Provider did not re-certify the plan of care in time
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your California physical therapy denials.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes segmented by payer and provider.
Physical Therapy Billing in California — Frequently Asked Questions
Do physical therapy billing rules differ in California?
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Medi-Cal is delivered through commercial managed care plans, each setting its own filing window and authorization rules.
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